| NPI | 1033979802 |
|---|---|
| Former Name | TYAN ROSE FAIRBANK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2024-03-20 |
| Last Update Date | 2024-06-04 |